Healthcare Provider Details

I. General information

NPI: 1962878256
Provider Name (Legal Business Name): REX TUTEN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 HABERSHAM AT NORTHLAKE BUILDING C, STE 100
TUCKER GA
30084
US

IV. Provider business mailing address

3530 HABERSHAM AT NORTHLAKE BUILDING C, STE 100
TUCKER GA
30084
US

V. Phone/Fax

Practice location:
  • Phone: 770-455-0835
  • Fax: 770-234-9664
Mailing address:
  • Phone: 770-455-0835
  • Fax: 770-234-9664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC001813
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: